Benefits of Outdoor Sports in Blue Spaces. The Case of School Nautical Activities in Viana do Castelo

Participating in outdoor sports in blue spaces is recognized to produce a range of significant social benefits. This case study empirically analyzes the social benefits associated with the School Nautical Activities project carried out in Viana do Castelo (Portugal) in school-age children and adolescents. It consisted of a 4 year program in which scholars took part in nautical activities (surfing, rowing, sailing, and canoeing) in blue spaces once a week during a semester as a part of their physical education course. The methods used for data collection were as follows: (1) a survey answered by 595 participants in the program and (2) five focus groups (FG): two FGs with participants (seven on each FG), two FGs with their parents (eight participants each), and one FG with the physical education teachers (five participants). Interviews were transcribed and qualitative analysis with NVivo software was developed. Results revealed clear evidence on the social benefits for school-age children and adolescents associated with participation in outdoor activities in blue spaces both in the overall health and in all the following analyzed categories: mental health and well-being, education, active citizenship, social behavior, and environmental awareness. More than 40% state that their overall health is much better now (13.4%) or somewhat better now (29.9%) due to their participation in the program. Thus, this article provides support for the anecdotal recognition of the benefits for school-age children and adolescents from participating in sports in the outdoors and especially in blue spaces.

Service Quality for Sports and Active Aging in Japanese Community Sports Clubs

(1) Background: This study aims to examine the association between service quality for sports and active aging and the impacts on different age cohorts; (2) Methods: This cross-sectional study used a convenience sample of 545 Japanese community sports club (CSC) members over 60 years old, recruited from across eight CSCs in Japan between 2012-2013. A self-administered questionnaire was used to measure the self-reported health status of the elderly, evaluations to CSCs, demographic characteristics, and information on sports programs; (3) Results: The results of multiple logistic regression showed that domains of general evaluation for sports (OR = 1.942 and 95% CI 1.336~2.824), benefits of sports (OR = 1.659 and 95% CI 1.344~2.047), and management in sports (OR = 1.273 and 95% CI 1.011~1.603) were important for club members aged 60-64, the young-old, and the old-old, respectively. With a reduced model for elderly members, stratified analyses showed a significant impact of service quality for sports on active aged people in the benefits and management domains, regardless of sociodemographic information or club participation behavior; (4) Conclusions: The findings suggest that the services encountered in sports are key to promoting health in a community. Service quality in age segmentation should be considered to promote and manage active aging in the future.

Potential Risk of Higenamine Misuse in Sports: Evaluation of Lotus Plumule Extract Products and a Human Study

Since 2017, higenamine has been added to the World Anti-Doping Agency (WADA) prohibited list as a β2-agonist prohibited at all times for sportspersons. According to WADA's report, positive cases of higenamine misuse have been increasing yearly. However, higenamine occurs naturally in the Chinese herb lotus plumule-the green embryo of lotus (Nelumbo nucifera Gaertn) seeds-commercially available as concentrated powder on the Asian market. This study evaluated the major phytochemical components of lotus plumule products using an appropriate extraction method, followed by a human study in which the products were orally administered in multiple doses to investigate the risk of doping violations. Comparing various extraction methods revealed that optimized microwave-assisted extraction exhibited the highest extraction efficiency (extraction time, 26 min; power, 1046 W; and temperature, 120 °C). Subsequently, the alkaloids in lotus plumule products were quantitatively confirmed and compared. Human study participants (n = 6) consumed 0.8 g of lotus plumule (equivalent to 679.6 μg of higenamine) three times daily for three consecutive days. All participants' urinary higenamine concentrations exceeded the WADA reporting cut-off of 10.0 ng/mL. Accordingly, lotus plumule consumption may engender adverse analytical findings regarding higenamine. Athletes should avoid consuming lotus plumule-containing products during in- and out-of-competition periods.

Validation and Adaptation of the Prosocial and Antisocial Behavior in Sport Scale to the Spanish context of Physical Education

Physical education (PE), by its own characteristics, is a subject where social communication is especially promoted. However, it is necessary to have tools that evaluate the social behaviour of students during PE classes. For this reason, we propose to validate and adapt the Prosocial and Antisocial Behavior in Sport Scale to the Spanish context of PE classes. The study involved 1081 students aged 12 to 18 (M = 14.83; SD = 1.27). The psychometric properties of the Prosocial Behavior Scale were analyzed through several statistical analyses. The results of the confirmatory factorial analysis and the exploratory factorial analysis supported the internal structure of the questionnaire. In addition, the scale was invariant to gender. Cronbach's alpha values were higher than 0.70 in the factors and sub-factors, finally showing adequate levels of temporal stability. Taking into account the results achieved in the present study, PE teachers have an effective tool to assess the social and antisocial behaviour of their students' students during PE classes.

[ECG in sportsmen: Distinguishing the normal from the pathological]

An ECG is recommended by the French Society of Cardiology in the screening of a competitive athlete. An intense and prolonged physical activity (>4 hours of intense sport/week) can lead to a physiological electric remodeling. In addition to physical activity (type, intensity, duration), the ECG should be interpreted according to the athlete's ethnicity and age. It is necessary to know the physiological modifications related to sport practice to avoid either false reassurances or the realization of unjustified additional examinations because of a wrong interpretation. The latest athlete ECG classification published in 2017 can be used to identify in which athlete additional tests are recommended (figure 1).

Transwomen in elite sport: scientific and ethical considerations

The inclusion of elite transwomen athletes in sport is controversial. The recent International Olympic Committee (IOC) (2015) guidelines allow transwomen to compete in the women's division if (amongst other things) their testosterone is held below 10 nmol/L. This is significantly higher than that of cis-women. Science demonstrates that high testosterone and other male physiology provides a performance advantage in sport suggesting that transwomen retain some of that advantage. To determine whether the advantage is unfair necessitates an ethical analysis of the principles of inclusion and fairness. Particularly important is whether the advantage held by transwomen is a tolerable or intolerable unfairness. We conclude that the advantage to transwomen afforded by the IOC guidelines is an intolerable unfairness. This does not mean transwomen should be excluded from elite sport but that the existing male/female categories in sport should be abandoned in favour of a more nuanced approach satisfying both inclusion and fairness.

Large divergence in testosterone concentrations between men and women: Frame of reference for elite athletes in sex-specific competition in sports, a narrative review

OBJECTIVE

The purpose of this narrative review was to summarize available data on testosterone levels in normal, healthy adult males and females, to provide a physiologic reference framework to evaluate testosterone levels reported in males and females with conditions that elevate androgens, such as disorders of sex development (DSD), and to determine the separation or overlap of testosterone levels between normal and affected males and females.

METHODS

A literature review was conducted for published papers, from peer reviewed journals, reporting testosterone levels in healthy males and females, males with 46XY DSD, and females with hyperandrogenism due to polycystic ovary syndrome (PCOS). Papers were selected that had adequate characterization of participants, and description of the methodology for measurement of serum testosterone and reporting of results.

RESULTS

In the healthy, normal males and females, there was a clear bimodal distribution of testosterone levels, with the lower end of the male range being four- to fivefold higher than the upper end of the female range(males 8.8-30.9 nmol/L, females 0.4-2.0 nmol/L). Individuals with 46XY DSD, specifically those with 5-alpha reductase deficiency, type 2 and androgen insensitivity syndrome testosterone levels that were within normal male range. Females with PCOS or congenital adrenal hyperplasia were above the normal female range but still below the normal male range.

CONCLUSIONS

Existing studies strongly support a bimodal distribution of serum testosterone levels in females compared to males. These data should be considered in the discussion of female competition eligibility in individuals with possible DSD or hyperandrogenism.

Changes in hemoglobin profile reflect autologous blood transfusion misuse in sports

The changes in hemoglobin (Hb) profile following autologous blood transfusion (ABT) for the first time were studied for anti-doping purposes. Twenty-four healthy, trained male subjects (aged 18‒40) were enrolled and randomized into either the transfusion (T) or control (C) groups. Blood samples were taken from the T subjects at baseline, after withdrawal and reinfusion of 450 ml of refrigerated or cryopreserved blood, and from C subjects at the same time points. Hematological variables (Complete blood count, Reticulocytes, Immature Reticulocytes Fraction, Red-cell Distribution Width, OFF-hr score) were measured. The Hb types were analyzed by high-performance liquid chromatography and the Hemoglobin Profile Index (HbPI) arbitrarily calculated. Between-group differences were observed for red blood cells and reticulocytes. Unlike C, the T group, after withdrawal and reinfusion, showed a significant trend analysis for both hematological variables (Hemoglobin concentration, reticulocytes, OFF-hr score) and Hb types (glycated hemoglobin-HbA1c, HbPI). The control charts highlighted samples with abnormal values (> 3-SD above/below the population mean) after reinfusion for hematological variables in one subject versus five subjects for HbA1c and HbPI. A significant ROC-curve analysis (area = 0.649, p = 0.015) identified a HbA1c cut-off value ≤ 2.7% associated to 100% specificity of blood reinfusion (sensitivity 25%). Hemoglobin profile changed in trained subjects after ABT, with abnormal values of HbA1c and HbPI in 42% of subjects after reinfusion. Future studies will confirm the usefulness of these biomarkers in the anti-doping field.

[Not Available]

Low adherence to recommended pre-participation cardiac evaluation of Swedish athletes Pre-participation cardiac evaluation of athletes is recommended by international organizations like the European Society of Cardiology and the American Heart Association, as well as by the Swedish Sports Confederation. The purpose of the evaluation is to prevent sudden cardiac death in athletes by early identification of individuals at risk. To our knowledge, no previous study has been made regarding the implementation of pre-participation cardiac evaluation of athletes in Sweden. We performed an electronical survey addressing sports clubs in one out of 21 districts in which the Swedish Sports Confederation is geographically divided. Only four out of 22 responding clubs with elite athletes preformed cardiac evaluation. Lack of knowledge about the recommendations as well as how to perform the evaluation were mentioned as reasons not to evaluate the athletes. Our results indicate the need for more information about pre-participation cardiac evaluation of athletes in Sweden.

Sport science internships for learning: a critical view

Sport science has gained vast popularity with students who have an interest in both physiology and the underpinning mechanisms of exercise concerning performance and health. The high numbers of graduates each year, coupled with the low number of graduate positions working in sports, has led to a high level of competition between students. To stand out from the crowd, sport science students may undertake an internship placement as part of their course, designed to enhance theoretical, practical, and soft skills in an applied setting. In the present article, we highlight some of the positives and negatives of sport science internships and ways in which they can be implemented and facilitated. Suggestions have also been provided to make students more aware of the reality of working in professional sports, which includes awareness of the potential for long and unsociable hours of work.

A systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches and officials

BACKGROUND

The aim of the current study was to conduct a systematic review determining the effect of sport-specific mental health awareness programs to improve mental health knowledge and help-seeking among sports coaches, athletes and officials. The second aim was to review the study quality and to report on the validity of measures that were used to determine the effectiveness of programs.

METHODS

Sport-specific mental health awareness programs adopting an experimental or quasi-experimental design were included for synthesis. Six electronic databases were searched: PsycINFO, MEDLINE (OVID interface), Scopus, Cochrane, CINAHL and SPORTDiscus. Each database was searched from its year of inception to October 2016. Risk of bias was assessed using the Cochrane and QATSQ tools.

RESULTS

Ten studies were included from the 1216 studies retrieved: four comprising coaches or service providers, one with officials, four with athletes, and one involved a combination of coaches and athletes. A range of outcomes was used to assess indices of mental health awareness and well-being. Mental health referral efficacy was improved in six studies, while three reported an increase in knowledge about mental health disorders. However, seven studies did not report effect sizes for their outcomes, limiting clinically meaningful interpretations. Furthermore, there was substantial heterogeneity and limited validity in the outcome measures of mental health knowledge and referral efficacy. Seven studies demonstrated a high risk of bias.

CONCLUSIONS

Further, well-designed controlled intervention studies are required. Researchers, practitioners and policy makers should adhere to available methodological guidance and apply the psychological theory of behaviour change when developing and evaluating complex interventions.

TRIAL REGISTRATION

PROSPERO CRD42016040178.

Education in Anti-Doping: The Art of Self-Imposed Constraints

The pillars of anti-doping are detection, deterrence, and prevention. Detection takes the form of testing for banned substances. Deterrence builds on testing and gathering evidence. Athletes who test positive are exposed to penalties. The main tool of prevention is education. Education takes many forms and can be implemented in many ways. This chapter addresses the nature and challenges of current anti-doping education. Firstly, general goals of education and their connection to sport are discussed. Secondly, three normative interpretations of sport are presented, and their implications for anti-doping education are examined. Instrumentalist interpretations and interpretations with emphasis on performance and enhancement challenge the anti-doping campaign. A human excellence interpretation is advocated in which anti-doping is considered a consistent and integral part of sport. Thirdly, future challenges for anti-doping education are reflected upon.

Navigating Motherhood and the Role of the Head Athletic Trainer in the Collegiate Setting

CONTEXT

Motherhood has been identified as a barrier to the head athletic trainer (AT) position. Role models have been cited as a possible facilitator for increasing the number of women who pursue and maintain this role in the collegiate setting.

OBJECTIVE

To examine the experiences of female ATs balancing motherhood and head AT positions in the National Collegiate Athletic Association Division II and III and National Association of Intercollegiate Athletics settings.

DESIGN

Qualitative study.

SETTING

National Collegiate Athletic Association Divisions II and III and National Association of Intercollegiate Athletics.

PATIENTS OR OTHER PARTICIPANTS

A total of 22 female head ATs (average age = 40 ± 8 years) who were married with children completed our study. Our participants had been certified for 15.5 ± 7.5 years and in their current positions as head ATs for 9 ± 8 years.

DATA COLLECTION AND ANALYSIS

We conducted online interviews with all participants. Participants journaled their reflections on a series of open-ended questions pertaining to their experiences as head ATs. Data were analyzed following a general inductive approach. Credibility was confirmed through peer review and researcher triangulation.

RESULTS

We identified 3 major contributors to work-life conflict. Two speak to organizational influences on conflict: work demands and time of year. The role of motherhood, which was more of a personal contributor, also precipitated conflict for our ATs. Four themes emerged as work-life balance facilitators: planning, attitude and perspective, support networks, and workplace integration. Support was defined at both the personal and professional levels.

CONCLUSIONS

In terms of the organization, our participants juggled long work hours, travel, and administrative tasks. Individually and socioculturally, they overcame their guilt and their need to be present and an active part of the parenting process. These mothers demonstrated the ability to cope with their demanding roles as both moms and head ATs.

[Demedicalisation of “Medical prescription of sport”: The Strasbourg programme as Viewed by Sports Educators]

Promoting health by sport has now gone one step further. Integrated into the 2015 Health Act, medical prescription of sport activities is organized locally, as illustrated by the Strasbourg “sport-health prescription” programme, which promotes physical activity for patients with stable chronic diseases within local sports structures. Observation of the real functioning of this programme, based on the practices and descriptions of six sports educators in various structures, reveals demedicalisation in favour of sportification, as sports educators translate the prescription according to their specific institution and policies. Although there is a general consensus about the need for physical education to fight against inactivity and isolation of patients, the expected effects of physical activity are redefined according to a political economy of local structures. Implementation of the sport-health programme is subject to the social and political conditions of the local sports movement.

Variability in Institutional Screening Practices Related to Collegiate Student-Athlete Mental Health

CONTEXT

Universal screening for mental health concerns, as part of the preparticipation examination in collegiate sports medicine settings, can be an important and feasible strategy for facilitating early detection of mental health disorders.

OBJECTIVE

To assess whether sports medicine departments at National Collegiate Athletic Association (NCAA) member colleges have policies related to identifying student-athlete mental health problems, the nature of preparticipation examination screening related to mental health, and whether other departmental or institutional screening initiatives are in place. I also aimed to characterize the variability in screening by institutional characteristics.

DESIGN

Cross-sectional study.

SETTING

College sports medicine departments.

PATIENTS OR OTHER PARTICIPANTS

Team physicians and head athletic trainers at NCAA member colleges (n = 365, 30.3% response rate).

MAIN OUTCOME MEASURE(S)

Electronic survey of departmental mental health screening activities.

RESULTS

A total of 39% of respondents indicated that their institution had a written plan related to identifying student-athletes with mental health concerns. Fewer than half reported that their sports medicine department administers a written or verbal screening instrument for symptoms of disordered eating (44.5%), depression (32.3%), or anxiety (30.7%). The strongest predictors of mental health screening were the presence of a written plan related to identifying student-athlete mental health concerns and the employment of a clinical psychologist. Additionally, Division I institutions and institutions with a greater ratio of athletic trainers to student-athletes tended to engage in more screening.

CONCLUSIONS

The substantial among-institutions variability in mental health screening suggests that opportunities exist to make these practices more widespread. To address this variability, recent NCAA mental health best-practice guidelines suggested that institutions should screen for a range of mental health disorders and risk behaviors. However, at some institutions, staffing deficits may need to be addressed to allow for implementation of screening-related activities.

Do current sports nutrition guidelines conflict with good oral health?

For optimal athletic performance, an athlete requires good oral health to reduce the risk of oral pain, inflammation, and infection and thereby minimize the use of analgesics and antimicrobial agents. Increased intake, frequency, and dental contact time of carbohydrate-rich foods, sports nutrition products, and acidic carbohydrate-containing sports and energy drinks may contribute to risks of dental erosion, caries, and inflammatory periodontal conditions in the athlete, especially when he or she also exhibits dehydration and poor oral hygiene habits. Examining the athlete before he or she begins participating in a sport allows the dental care provider to determine the patient's existing oral health, hygiene, and susceptibility to risk factors for erosion, caries, and inflammatory periodontal disease. This oral profile, in conjunction with the individual athlete's dietary needs, can be used to establish a treatment and preventive program, including oral health education. Good oral hygiene practices and application of topical fluoride, especially via fluoridated toothpastes and topical fluoride varnishes, must be available to the athlete. Rinsing with water or a neutral beverage after exposure to carbohydrates or acidic sports nutrition products may reduce carbohydrate contact time and bring oral pH levels back to neutral more quickly, reducing the risk of caries and erosion. Finally, the dentist should encourage the athlete to consult with an experienced sports dietitian to ensure that principles of sports nutrition are being appropriately applied for the type, frequency, and duration of exercise in consideration of the individual's oral health needs.

Mandatory mouthguard rules for high school athletes in the United States

High school athletes seem particularly predisposed to dental injury, but athletic mouthguards have an excellent track record of success in reducing the severity and incidence of dental injuries in sports. Therefore, it has been suggested that mouthguards be made mandatory for high school athletes who participate in sports with risk of injury. The National Federation of State High School Associations currently recommends that mouthguards be mandated for high school football, lacrosse, ice hockey, and field hockey players as well as for wrestlers who are wearing orthodontic appliances. Different states have tried to mandate additional sports with varying degrees of success. This article summarizes the process that leads to rule changes for high school athletes at the national level and discusses the history of 4 states--Minnesota, Maine, New Hampshire, and Massachusetts--that have tried to mandate mouthguards for different sports. Common complaints that lead to the cessation of mouthguard rules, such as speech considerations, breathing ability, and cleanliness, are discussed.

The Preparticipation Sports Evaluation

The preparticipation physical evaluation is a commonly requested medical visit for amateur and professional athletes of all ages. The overarching goal is to maximize the health of athletes and their safe participation in sports. Although studies have not found that the preparticipation physical evaluation prevents morbidity and mortality associated with sports, it may detect conditions that predispose the athlete to injury or illness and can provide strategies to prevent injuries. Clearance depends on the outcome of the evaluation and the type of sport (and sometimes position or event) in which the athlete participates. All persons undergoing a preparticipation physical evaluation should be questioned about exertional symptoms, presence of a heart murmur, symptoms of Marfan syndrome, and family history of premature serious cardiac conditions or sudden death. The physical examination should focus on the cardiovascular and musculoskeletal systems. U.S. medical and athletic organizations discourage screening electrocardiography and blood and urine testing in asymptomatic patients. Further evaluation should be considered for persons with heart or lung disease, bleeding disorders, musculoskeletal problems, history of concussion, or other neurologic disorders.

Hurdling over sex? Sport, science, and equity

Between 1968 and 1999, the International Olympic Committee (IOC) required all female athletes to undergo genetic testing as part of its sex verification policy, under the assumption that it needed to prevent men from impersonating women and competing in female-only events. After critics convinced officials that genetic testing was scientifically and ethically flawed for this purpose, the IOC replaced the policy in 1999 with a system allowing for medical evaluations of an athlete's sex only in cases of "reasonable suspicion," but this system also created injustice for athletes and stoked international controversies. In 2011, the IOC adopted a new policy on female hyperandrogenism, which established an upper hormonal limit for athletes eligible to compete in women's sporting events. This new policy, however, still leaves important medical and ethical issues unaddressed. We review the history of sex verification policies and make specific recommendations on ways to improve justice for athletes within the bounds of the current hyperandrogenism policy, including suggestions to clarify the purpose of the policy, to ensure privacy and confidentiality, to gain informed consent, to promote psychological health, and to deploy equitable administration and eligibility standards for male and female athletes.

Initial development of the Coach Identity Prominence Scale: a role identity model perspective

The focus of this multiphase research was to generate and test the psychometric parameters of the Coach Identity Prominence Scale (CIPS). First, a pilot study was conducted with context (n = 10) and construct (n = 6) specialists, who evaluated the technical quality and content validity of 20 items developed from semistructured interviews. Thirteen items were selected for Study 1, which tested the factorial validity and reliability scores of coaches' (n = 343) responses to the CIPS items. An eight-item structure, consisting of two factors (centrality and evaluative emotions) was selected as the final CIPS measure, which was examined with a final sample of coaches (n = 454) in Study 2 to evaluate the factorial validity, group invariance, concurrent validity, and nomological validity of respondents' scores to the CIPS. Initial evidence for the various types of validity and reliability tested across the studies was provided.

Evaluation of a cross-sector community initiative partnership: delivering a local sport program

Corporate community initiatives (CCI) are often established via cross-sector partnerships with nonprofit agencies to address critical social problems. While there is a growing body of literature exploring the effectiveness and social impact of these partnerships, there is a limited evaluative research on the implementation and execution processes of CCIs. In this paper, we examined the implementation and operational processes in the delivery of a professional sport organization's CCI initiative using program theory evaluation. The findings showed discrepancies between the associate organization and the implementers regarding understanding and fulfilling responsibilities with performing certain aspects (maintaining accurate records and program marketing) of the service delivery protocol. Despite program stakeholders being satisfied overall with the program delivery, contradictions between program stakeholders' satisfaction in the quality of program delivery was found in critical components (marketing and communications) of the service delivery. We conclude that ongoing evaluations are necessary to pinpoint the catalyst of the discrepancies along with all partners valuing process evaluation in addition to outcome evaluation.

Team perfectionism and team performance: a prospective study

Perfectionism is a personality characteristic that has been found to predict sports performance in athletes. To date, however, research has exclusively examined this relationship at an individual level (i.e., athletes' perfectionism predicting their personal performance). The current study extends this research to team sports by examining whether, when manifested at the team level, perfectionism predicts team performance. A sample of 231 competitive rowers from 36 boats completed measures of self-oriented, team-oriented, and team-prescribed perfectionism before competing against one another in a 4-day rowing competition. Strong within-boat similarities in the levels of team members' team-oriented perfectionism supported the existence of collective team-oriented perfectionism at the boat level. Two-level latent growth curve modeling of day-by-day boat performance showed that team-oriented perfectionism positively predicted the position of the boat in midcompetition and the linear improvement in position. The findings suggest that imposing perfectionistic standards on team members may drive teams to greater levels of performance.

Transition to non-toxic gunshot use in Olympic shooting: policy implications for IOC and UNEP in resolving an environmental problem

Olympic shooters discharge, annually, thousands of tons of lead shot which pose toxic risks to animals and may pollute both surface and ground waters. Non-toxic steel shot is an acceptable and effective substitute, but International Shooting Sports Federation (ISSF) rules prevent its adoption. The present policy and rules of the ISSF on lead shot use contravene the International Olympic Committee (IOC) Charter position on environmental protection. The United Nations Environment Programme (UNEP), a formal Olympic partner on environmental protection, has no stated policy on contamination from lead ammunition, despite having declared lead a Priority Area for remedial action, and is pressing to remove lead from the global human environment. The IOC Sport and Environment Commission and UNEP could examine the continued use of lead shot ammunition and advise the IOC Executive Board on appropriate changes in policy and rules that could halt the massive lead shot contamination of shooting range environments world-wide.

[Sports and athletes deserve doping hunting]

This article reviews the evidence-based ergogenic potential adverse effects of the most common products in use by recreational and elite athletes today. This is an aggressively marketed and controversial area of sports medicine wordwide. It is therefore important for the scientific societies, clinicians, dieticians sports federations to be well versed in the more popular supplements and drugs in order to have an important role in information and prevention attitudes that can lead to health risks or addictions!

Standards of nutrition for athletes in Germany

The Deutscher Olympische Sportbund (DOSB) founded recently an advisory board for German elite athlete nutrition, the 'Arbeitsgruppe (AG) Ernahrungsberatung an den Olympiastutzpunkten'. The 'Performance codex and quality criteria for the food supply in facilities of German elite sports' have been established since 1997. The biochemical equivalent (ATP) for the energy demand is calculated using the DLW (Double Labeled Water)-method on the basis of RMR (Resting Metabolic Rate) and BMR (Basic Metabolic Rate) at sport type specific exercises and performances. Certain nutraceutical ingredients for dietary supplements can be recommended. However, quality criteria for nutrition, cooking and food supply are defined on the basis of Health Food and the individual physiological/social-psychological status of the athlete. Especially food supplements and instant food have to be avoided for young athletes. The German advisory board for elite athlete nutrition publishes 'colour lists' for highly recommended (green), acceptable (yellow), and less recommended (red) food stuff.

Instruments for measuring service quality in sport and physical activity services

Studies that conceptualize and measure quality in sport services date back to the last two decades. The present study aims to examine quality in sport services in terms of the classification of participant services and spectator services and to provide a summary of the empirical studies carried out to date. This study demonstrates that sport services literature is still in its infancy and no agreement exists on the developed models. Furthermore, the research models examined indicate that sports services not only possess different attributes and dimensions than other service industries but also differ in themselves. Consequently, the produced models need to be tested in the future on different sample groups for further clarification.

Athletes' perceptions of role ambiguity and coaching competency in sport teams: a multilevel analysis

The purpose of this study was to examine the relationship between athletes' perceptions of role ambiguity and two theoretically derived dimensions of coaching competency (i.e., game strategy and technique competencies). A total of 243 players from 26 teams representing various interdependent sports completed French versions of the Role Ambiguity Scale and the Coaching Competency Scale. Multilevel analyses supported the existence of relationships between the four dimensions of role ambiguity and the two dimensions of coaching competency at both individual and team levels. When the levels were considered jointly, athletes perceiving greater ambiguity in their role in both offensive and defensive contexts were more critical of their coach's capacities to lead their team during competitions and to diagnose or formulate instructions during training sessions. The results also indicated that the dimension of scope of responsibilities was the main contributor to the relationship with coaching competency at an individual level, whereas role evaluation was the main contributor to this relationship at a group level. Findings are discussed in relation to the role episode model, the role ambiguity dimensions involved in the relationships according to the level of analysis considered, and the salience of ambiguity perceptions in the offensive context.

Out of bounds? A critique of the new policies on hyperandrogenism in elite female athletes

In May 2011, more than a decade after the International Association of Athletics Federations (IAAF) and the International Olympic Committee (IOC) abandoned sex testing, they devised new policies in response to the IAAF's treatment of Caster Semenya, the South African runner whose sex was challenged because of her spectacular win and powerful physique that fueled an international frenzy questioning her sex and legitimacy to compete as female. These policies claim that atypically high levels of endogenous testosterone in women (caused by various medical conditions) create an unfair advantage and must be regulated. Against the backdrop of Semenya's case and the scientific and historical complexity of "gender verification" in elite sports, we question the new policies on three grounds: (1) the underlying scientific assumptions; (2) the policymaking process; and (3) the potential to achieve fairness for female athletes. We find the policies in each of these domains significantly flawed and therefore argue they should be withdrawn.

Empirical verification of the weighted system of criteria for the elite water polo players quality evaluation

The aim of this research was to check the validity of the weighed system of criteria for evaluating the actual quality of water polo players proposed by Hraste, Dizdar and Trninić. The authors have determined the attributes of the measurement instrument for assessment of the overall performance efficiency of elite water polo players. Based on the determined descriptive indicators, on the coefficients of the relative importance of criteria, and on the degree of the objectivity level (interobservers' agreement) of the expert evaluations, it can be concluded that the measuring attributes (objectivity and sensitivity) for most of the criteria are in accordance with their relative importance coefficients for a particular position in the game. Consequently, a structure of relevant criteria is proposed for each play action position in the water polo game. The established instrument for evaluation the actual quality of the elite water polo players is a precondition to establish the professional system orientation, but it would also mean and a hypotheses for adequate design tactic model of play and a process of sports preparation. In succeeding steps of developing the system of criteria and its applicability, the latent structure of the criteria variables should be determined as well as overall importance of criteria with respect to the game of water polo.

[Medication, athletes and doping regulations]

Doping is defined as an offence of the antidopingcode of the World Anti-Doping Agency (WADA). To uphold the code WADA has composed a list of prohibited substances and methods. The composition of the list is based on three mainstays: fair play, health risks and spirit of the sport. Among the prohibited substances are anabolic agents, erythropoietin, beta2-sympathicomimetics, growth hormone and masking agents. For some medications athletes may receive a therapeutic use exemption. Enforcement of the antidoping-code is performed by doping controls. For this purpose, blood and urine samples of athletes are collected and analysed. In 2006 approximately 200,000 samples were analysed worldwide, with 1.96% being tested positive. All physicians should be aware of the possibility that athletes use medication subjected to the doping regulations. There are guidelines for physicians on doping-related issues in medical practice.

Medical conditions affecting sports participation

Children and adolescents with medical conditions present special issues with respect to participation in athletic activities. The pediatrician can play an important role in determining whether a child with a health condition should participate in certain sports by assessing the child's health status, suggesting appropriate equipment or modifications of sports to decrease the risk of injury, and educating the athlete, parent(s) or guardian, and coach regarding the risks of injury as they relate to the child's condition. This report updates a previous policy statement and provides information for pediatricians on sports participation for children and adolescents with medical conditions.

Bayesian detection of abnormal hematological values to introduce a no-start rule for heterogeneous populations of athletes

Sports authorities exclude athletes with abnormal levels of blood parameters. Here, the consideration of longitudinal blood profiles together with heterogeneous factors such as ethnicity and age produces a model with enhanced sensitivity to detect blood doping. Sports disciplines with heterogeneous populations now have a general method to introduce the no-start rule.

National athletic trainers' association position statement: management of the athlete with type 1 diabetes mellitus

OBJECTIVE

To present recommendations for the certified athletic trainer in the management of type 1 diabetes in the athlete.

BACKGROUND

In managing diabetes, the most important goal is to keep blood glucose levels at or as close to normal levels as possible without causing hypoglycemia. This goal requires the maintenance of a delicate balance among hypoglycemia, euglycemia, and hyperglycemia, which is often more challenging in the athlete due to the demands of physical activity and competition. However, effectively managing blood glucose, lipid, and blood pressure levels is necessary to ensuring the long-term health and well-being of the athlete with diabetes.

RECOMMENDATIONS

These recommendations are intended to provide the certified athletic trainer participating in the management of an athlete with type 1 diabetes mellitus with the specific knowledge and problem-solving skills needed. Athletic trainers have more contact with the athlete with diabetes than most members of the diabetes management team do and so must be prepared to assist the athlete as required.